RUSSELL ROY WHITEHEAD

FORT WAYNE, IN
NPI1801844659
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy1041C0700X Social Worker, Clinical
(Licence: IN  34001909A)
Enumeration Date2006-05-04
Last Update Date2007-07-08
Business Address
-- RUSSELL ROY WHITEHEAD MSW, LCSW
909 E STATE BLVD
FORT WAYNE, IN 46805-3404
Phone number: 260-481-2700
Mailing Address
-- RUSSELL ROY WHITEHEAD MSW, LCSW
909 E STATE BLVD
FORT WAYNE, IN 46805-3404
Phone number: 260-481-2700
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